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I Love My Doctor, But...!

June 14, 2009
by Mark Hagland
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I recently had a routine patient visit with my primary care physician. He's a great guy, and I've known him for many years. He's also a very good clinician, and I respect his knowledge and opinions. However...! I do find his opinions on EMRs quite frustrating. To begin with, he is an absolutely perfect candidate for an EMR; he has a two-site practice with locations in two different places on Chicago's North Side (several miles from one another), and patients who see him in both (including me). He is also affiliated with a large, integrated health system that presumably is beginning to automate its affiliated physician practices, though my doctor and I didn't have a chance to talk about that during my most recent visit. But when we discussed EMRs a year ago, my physician was highly dismissive of EMRs, a stance I had found quite shocking, really. For one thing, my doctor is my age--under 50; and he uses electronics and online communications in his personal life. And he certainly has every reason to move towards an EMR, in his two-physician, two-location practice, and in order to connect electronically with the health system with which he is affiliated. But his attitude, as expressed in our conversation a year ago, was essentially, "I won't do this unless they make it free and someone else handles pretty much handles every aspect of the implementation for me." For an under-50, otherwise "hip" physician, I was struck by the short-sightedness and lack of systems thinking my own personal physician expressed regarding EMRs--and he knows what I do and how much time and energy I put into writing about clinical automation and health information technology in my work. Still, my primary care physician's attitude is instructive, I think, as we try to move forward as a healthcare system. Contrary to what some might think (and also contrary to the mental image I tend to have in my head), it's not just the oldest, most technology-averse physicians who remain wary of the EMR journey; some middle-aged (I would posit that few under-35 MDs are likely in this category, but even there, I can't be 100-percent certain) doctors who are otherwise enlightened continue to resist EMR implementation on a combination of economic, hassle, and other grounds. So as CIOs and their teams in hospitals and integrated health systems try to move their organizations and broader affiliated enterprises forward on EMR/EHR, we're going to have to keep in mind that the level of conceptual consensus on automation that we tend to want to assume day-to-day, may not in fact yet fully exist. And we'll all have to figure out smart, savvy ways to bring along doctors like my own personal physician, who don't yet "get it."

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